Watchman a Big Hassle for approval

I have been working with Austin to see if I can get approved for the Watchman. It really has been a nightmare so far. They cannot even find my 2013 visit/consultation with Dr. Natale or a lot of my records they should have from the past. I keep getting told it is a extremely expensive procedure and Medicare is very hard with the criteria that has to maybe be approved. This has been ongoing for 2 weeks +.
I am about ready to throw my hands up and say forget it. Considering Medicare is being this hardcore for approval, It’s been a nightmare.

Anyway, Life is good just expensive on Eliquis.



Edited 1 time(s). Last edit at 05/29/2019 08:48AM by smackman.

I tried to get the Watchman here at Scripps in California. Private insurance would not approve.
It looks like next year with the Watchman Flex it will be easier to get approval.

The problem I am having now is I ended up in the ER three months ago with a gallbladder attack.
I was advised to have it removed. Especially being on Eliquis. Better a planned procedure that an emergency procedure.
I went to a good surgeon at Scripps. After she talked with Dr. Natale's staff about the Eliquis and bridging protocol, she said she is not willing to do the surgery under those terms. It has been a couple months and I still trying to get this worked out so I can have elective surgery. This type of scenario is why I wanted to have the Watchman.

I am hoping something can be worked out before i end up off of Eliquis for 4 or 5 days with a local emergency surgery situation.



Edited 1 time(s). Last edit at 05/28/2019 05:37PM by gmperf.

Smackman, best to roll with the punches a bit here. Watchman FLX will become easier in due time and when results from the latest several RCTs on Watchman coming out in next 6 to 12 months. You should then be able to get it before too much longer. You’ll be fine in the meantime, and it will all happen before too awfully long.

Gmperf, sorry to hear of your specific issue at Scripps. I am not sure why your elective procedure surgeon is balking at doing your procedure with the bridging protocol? Other than maybe since she views it as an elective procedure she would just rather wait until later when she use her own terms??

This too, should have a good solution but am sorry you might have to wait a bit longer to get it all done. Hang in there too!

Shannon



Edited 1 time(s). Last edit at 05/28/2019 06:10PM by Shannon.

Smackman I agree with Shannon. It will happen. Most likely it will become easier to get approval as time goes by. I personally would wait for the Watchman Flex as opposed to the current Watchman.

Hello Shannon,
I think the problem the surgeon had with the protocol was I was to start Eliquis back up the evening of the morning I had the surgery. The surgeon wanted to wait till the next day to start Eliquis. The surgeon said she spoke with her colleagues and they both agreed with her, they wouldn't do the surgery.

I went to two different doctors for opinions about the gallbladder attack. They both said once you start having gallbladder symptoms they almost always do not improve and usually become worse. Both said I should have the surgery as soon as possible rather than waiting because of the Eliquis being in the equation. They also said I can try lifestyle modifications, such as eating low fat, avoid fried foods, etc. Problem with that is I already do eat that way. LOL.

Besides being a bit frustrating, I find it all somewhat comical. The surgeon said "you are the healthiest patient I have." My CHADSVASC is 0. I have been on half dose Eliquis for a year, I am in NSR for almost 4 years, yet I can't get a simple surgery. God forbid something serious happens. This is the healthcare system my wife and I spend $2200.00 a month for, plus out of pocket.

At this point the surgeon says "no surgery with the protocol." The protocol is the protocol. The patient is between a rock and hard place trying to figure out how to make it all work.
I am sure it will workout somehow. I may visit Cedar Sinai or USC and see if they can make it all work.

Sorry Smackman, didn't mean to hijack your post. Good luck with your Watchamn.



Edited 1 time(s). Last edit at 05/28/2019 07:03PM by gmperf.

Gmperf, Sorry to hear about your situation, but if I may share my wife’s experience which might help you in the meantime. My wife has had gallbladder attacks for years and visited er many times and she was advised to have it removed as it almost never gets better on its own. She’s was 35 at the time and resisted to have the procedure as the removal involves many permanent side effects. We researched online and saw people bragging about gallbladder cleansing and it looked fairly easy to do. We agreed that if it didn’t work, when the next attack happens, we would have it removed. So we ended up doing the gallbladder cleanse and it worked. We repeated it twice in 6 months and she never had an issue again, that was 4 years ago, so I know it worked. There are many variations and if you need more info you can pm me. Here is a link with more info.

[wellnessmama.com]



Edited 1 time(s). Last edit at 05/29/2019 02:33AM by johnnyS.

I find this fascinating. Why would the surgeon object to that protocol? Is it because the patient might bleed the night of the surgery?

Gmperf and Brian_og, it’s likely because the general surgeons she consulted with to ask their opinion are going by the same very conservative rule of thumb on Eliquis, erring on the side of what they feel is iron clad assurance there won’t ever be a drop of extra blood from the procedure, when it’s quite likely they are not as familiar with using this bridging protocol from Scripps were they likely have much more experience with the protocol in real patients in which their goal is total protection against a possible embolic event in the knowledge and vast experience that there won’t be bleeding much at all with a 24 hour break before restarting Eliquis.

I can imagine the conversation between your gall bladder doc and her couple of colleagues she said she consulted with may have gone something like this: “Hi Frank (the name of her first consult , “I’ve got a patient for gall bladder removal and his heart surgeon wants me to use a protocol of starting back on Eliquis only 24 hours after surgery. I’m a little unsure about this and what do you think?” (Dr Frank replies) “Well, I’m like you, and since you are already unsure, I too always make darn sure there isn’t a drop of extra bleeding with my patients on those darn blood thinners.” Mainly reinforcing your docs hesitancy.

Or some such conversation, she likely expressed her own uncertain reservation to her colleagues who, as often might be the case in similar conversations they might be most prone to just agree with her uncertainty and err on the side of caution since they have likely never heard of such a protocol for patients who have had an LAA-Iso and who are still on Eliquis which is the least likely of the blood thinners to cause a post op bleeding issue and the general rule of thumb for surgeons and blood thinners is typically always more overkill than it has to be.

And Gmperf, I’m going to St Davids this weekend for the private celebration of the brand new Electrophysiology Center grand opening in an all new wing of the hospital there, And I will spend two days watching Dr Natale doing ablations and taking some pix and videos of the new facility to post on our new updated website this summer. While I am with Dr N., I’ll confirm with him the protocol you got at Scripps is the same they would advise at St Davids for a gall bladder removal and see if there is any leeway at all for maybe stretching the time before starting back on Eliquis to 36hrs post gall bladder removal, Gmperf.

Keep in mind that Dr. Natale and this bridging protocol will always prioritize preventing any possible embolic event, while keeping within the safe practical margins regarding minor bleeding risk a full day or more after a given procedure.

Cheers!
Shannon



Edited 1 time(s). Last edit at 05/29/2019 09:19AM by Shannon.

I will definitely put it on hold because there are possibilities I could have test run to see if I qualify and Medicare could refuse to pay for these test. For instance, A Echo Cardiogram. I had a couple years ago but these might not be adequate due to the age of these test 6+ years ago. That is one example.
Anyway, We are headed on a Alaskan Cruise so Life is good.

Also, It was emphasized to me it was a extremely expensive procedure



Edited 1 time(s). Last edit at 05/29/2019 01:05PM by smackman.

I was not approved for the Watchman procedure. Your Chads Score has to be 3 and above. They say mine is 2. Honestly, That is the first time anyone has given me a Chad’s score.
Here is the explanation;
Mr. Hayes:
I left you a voice message earlier today on home number- I was unable to reach you on cell phone- line was constantly busy. I have reviewed your records again with my manager who does preliminary reviews for approval for the LAA closure procedures.
Unfortunately you do not meet the medical necessity criteria for insurance to cover the procedure. You need a Chads Vasc score of 3 or greater and your score is 2 (1 point for the coronary artery disease and 1 point for high blood pressure. We also need a documented need to come off of the blood thinner such as problems with bleeding or previous symptoms of either transient ischemic attacks or stroke. I understand that you don’t like taking the blood thinners and that they are expensive but that is not a sufficient reason for the insurance company.

Anyway, That’s the answer from Austin. Life is good.

Yeah, unfortunately that's the policy a lot of insurance companies still have. They're coming around but it's a slow process.

Thanks Johnny for the information. I am a bit skeptical of some of these types of treatments. Over the years of trying alternative treatment and supplement, the only ones that seemed to help have bean eating clean, magnesium, and potassium. I may look into this.

Thanks Shannon. I believe both sides of the anticoagulant position are biased to their position. Dr Natale came up with a possible solution of trying to get a Watchman approval.
Thanks for your help as always.

Don